Fatigue, sleepiness, and physical activity in patients with multiple sclerosis.

Fatigue is a frequent and disabling symptom in patients with multiple sclerosis (MS). The objective of the study was to compare fatigue and sleepiness in MS, and their relationship to physical activity. Eighty patients with MS rated the extent of experienced fatigue (Fatigue Severity Scale, FSS) and sleepiness (Epworth Sleepiness Scale, ESS). The relationship between the scales was analysed for the scales as a whole and for single items. The clinical status of the patients was measured with the Extended Disability Status Scale (EDSS). In addition, physical activity was recorded continuously for 1 week by wrist actigraphy. The mean scores of fatigue and sleepiness were significantly correlated (FSS vs. ESS r=0.42). Single item analysis suggests that fatigue and sleepiness converge for situations that demand self-paced activation, while they differ for situations in which external cues contribute to the level of activation. While fatigue correlated significantly with age (r=0.40), disease severity (EDSS, r=0.38), and disease duration (r=0.25), this was not the case for sleepiness. Single patient analysis showed a larger scatter of sleepiness scores in fatigued patients (FSS>4) than in non-fatigued patients. Probably, there is a subgroup of MS patients with sleep disturbances that rate high on ESS and FSS. The amount of physical activity, which was measured actigraphically, decreased with disease severity (EDSS) while it did not correlate with fatigue or sleepiness.

[Drug-induced eosinophilic pneumonia]. / Eosinophile Pneumonie als unerwünschte Arzneimittelwirkung.

Eosinophilic pneumonia is a lung disorder characterized by eosinophilic pulmonary infiltration and blood eosinophilia. It can be caused by a variety of drugs. Especially in mild forms and in chronically neurologically ill patients, it can be difficult to spot. We report the case of a 46-year-old woman suffering from multiple sclerosis who developed nitrofurantoin-induced eosinophilic pneumonia.

Efficacy and safety of high-dose cabergoline in Parkinson's disease.

OBJECTIVES: To assess the efficacy and safety of high-dose (up to 20 mg/day) cabergoline in Parkinson's disease (PD) patients with motor fluctuations and/or dyskinesias. MATERIALS AND METHODS: Thirty-four PD patients had cabergoline up-titrated and their levodopa (L-dopa) reduced over a maximum of 20 weeks, followed by at least 6 weeks steady cabergoline dosing. Primary endpoint was change in mean hyperkinesia intensity at the final visit (week 26). RESULTS: Mean (+/- SD) cabergoline was increased from 6.43 +/- 2.66 to 12.78 +/- 5.67 mg/day and mean L-dopa reduced from 606.6 +/- 263.9 to 370.6 +/- 192.5 mg/day. A significant reduction (P < 0.001) in mean hyperkinesia intensity occurred from baseline (day 0) to week 26. Improvements in 'on with dyskinesias', mean dystonia intensity (P < 0.05), time spent in 'severe off' condition, severity of 'off' periods as well as clinical/patient global impression, and health-related quality of life were observed. Twenty-four drug-related adverse events were recorded of which four were regarded as serious. CONCLUSION: High-dose cabergoline was well tolerated and provided significant improvements in the Parkinson symptomatology and a reduced requirement for L-dopa.

[Multiple sclerosis--how specific is MRI?]. / MS--wie spezifisch ist das MRT?

Lesions detected in the white matter by T2-weighted MRI are often inadvertently attributed to multiple sclerosis (MS). This can, as in the following case of a 34-year-old woman, lead to an incorrect diagnosis. The patient had a left-sided atrial myxoma that served as a source of emboli, leading to multiple lacunar lesions. These were incorrectly interpreted as consistent with MS. We discuss the MRT criteria that can lead to specificity of lesions in white matter in patients with clinical symptoms suggestive of MS.

Facial affect recognition in the course of schizophrenia.

Deficits in facial affect recognition have been shown repeatedly in schizophrenia. However, the stability of this deficit over time remains to be clarified. A total of 36 remitted, 32 acutely ill schizophrenic patients and 21 healthy volunteers participated in a cross-sectional and longitudinal study. All subjects were assessed twice within 4 weeks (acute schizophrenics and normal controls), or 12 weeks, respectively (remitted schizophrenics). Subjects had to identify six basic emotions from corresponding facial expressions shown as photographs on a video screen. Both acute and remitted schizophrenics demonstrated a stable deficit over time in facial affect recognition unrelated to psychopathology and medication. This suggests that deficits in facial affect recognition in schizophrenia reflect a trait-like, rather than a state-dependent, characteristic.

[Are visual and auditory perception modified in psychopathological assessment of expressive markers of psychiatric patients?]. / Beeinflussen sich visuelle und auditive Wahrnehmung bei der psychopathologischen Beurteilung von Ausdrucksmerkmalen psychiatrischer Patienten?

The assessment of nonverbal expression (e.g. facial action, speech, body movements, etc.) are an important aspect of the diagnostic and prognostic process in psychiatric patients. By means of observer rating scales' expression is usually assessed on different observation levels. It appears that visual and auditory perception of expression interfere with one other. In the present study it was demonstrated, that ratings of certain attributes of expression was significantly more inconsistent in schizophrenic than in depressed patients, provided information was simultaneously displayed to both visual and auditory channels of perception. A "disintegration" of the components of expression in schizophrenics may explain why raters get differings impressions of the patient's overall expression. Moreover, the description of expressive behaviors seems to be influenced by diagnostic stereotypes. The development of a more objective method of assessment would therefore be promising.